Postoperative Nudges to Reduce Opioid Prescribing

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

640 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-10-19

Study Completion Date

2023-10-18

Brief Summary

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This study tests the effectiveness of two email-based behavioral nudges, one based on peer behavior and one based on best practice guidelines, in reducing excessive opioid prescriptions after surgery. It will be conducted in three surgical specialties (general surgery, orthopedic surgery, and obstetric/gynecological surgery) at 19 hospitals within one healthcare system. These specialties will each be randomized to a control group or one of two nudge groups. Each month for one year, surgeons in the nudge groups will receive emails comparing their opioid prescribing either to their peers' prescribing or to prescribing guidelines. Both types of email-based nudges are expected to reduce opioid prescribing after surgery.

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Detailed Description

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Conditions

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Opioid Prescribing

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

HEALTH_SERVICES_RESEARCH

Blinding Strategy

DOUBLE

Participants Caregivers

Study Groups

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Guideline-Based Nudges

Group Type EXPERIMENTAL

Guideline-Based (Injunctive Norm) Nudges

Intervention Type BEHAVIORAL

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. \[Name\],

In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures.

For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing.

We will continue to send you opioid prescribing safety reports.

Sincerely, \[Signature\]

\[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

Peer-Based Nudges

Group Type EXPERIMENTAL

Peer-Based (Social Norm) Nudges

Intervention Type BEHAVIORAL

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. \[Name\],

In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures.

YY% of \[specialty\] surgeons at Sutter Health prescribe within the ranges below for these procedures.

We will continue to send you opioid prescribing safety reports.

Sincerely, \[Signature\]

\[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Control

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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Guideline-Based (Injunctive Norm) Nudges

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. \[Name\],

In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amounts recommended by safety guidelines for these procedures.

For patient safety, Sutter Health recommends prescribing within the ranges below for these procedures. Doing so will also meet best-practice safety guidelines for post-operative opioid prescribing.

We will continue to send you opioid prescribing safety reports.

Sincerely, \[Signature\]

\[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

Intervention Type BEHAVIORAL

Peer-Based (Social Norm) Nudges

Surgeons in this arm will receive an email with the following content at the end of each month in which at least two of their patients are discharged with an opioid prescription that exceeds the prescribing guideline for the procedure performed.

Dear Dr. \[Name\],

In \[month\], at least XX of your patients were discharged with opioid prescriptions exceeding the amount prescribed by YY% of your peers for these procedures.

YY% of \[specialty\] surgeons at Sutter Health prescribe within the ranges below for these procedures.

We will continue to send you opioid prescribing safety reports.

Sincerely, \[Signature\]

\[Table displaying recommended ranges of 5mg oxycodone tablets for each procedure\]

The ranges of 5mg oxycodone tablets displayed will be the same as the ranges stipulated by the prescribing guidelines, but this nudge will not mention guidelines.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* the patient is at least 18 years old at the date of surgery
* the patient is discharged to their home
* the surgical procedure has an applicable post-operative opioid prescribing guideline
* the surgical procedure is the only surgical procedure performed during the patient's hospital stay
* the prescription is for an opioid taken orally (tablets, capsules, or liquid solution)

To avoid contamination between the intervention arms, surgeons who operate across multiple surgical specialties (defined as surgeons who performed less than 90% of their total procedures in one specialty between June 2020 and May 2021) will not be eligible.

Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No